title: The role of lymphadenectomy in cervical cancer patients: the significance of the number and the status of lymph nodes removed in 526 cases treated in a single institution.
abstract: OBJECTIVE
  To investigate whether the total number of removed lymph nodes (LNs) and the number of metastatic LNs would prove to be independent prognostic factors for survival in patients with cervical cancer (CC).
  
  
  METHODS
  Data from patients with CC who underwent radical surgery between March 1980 and September 2009 were reviewed. A total of 526 patients were included in the statistical analysis. Full pathologic evaluation was performed. The total number of examined LNs and their histopathological status were analyzed for their prognostic effect on survival by means of multivariable Cox proportional hazard regression models.
  
  
  RESULTS
  The median number (interquartile range) of total, pelvic, and para-aortic nodes removed was 37 (29-47), 34 (27-42), and 19 (14-24), respectively. Positive pelvic nodes were found in 102 of 526 (19%) patients. All 8 patients with para-aortic metastases had also pelvic node metastases. At multivariable analysis, vaginal involvement, type of lymphadenectomy and LN status all significantly negatively affected disease-free survival and overall survival, whereas the number of total LNs removed did not affect survival.
  
  
  CONCLUSIONS
  LN metastasis and number of LN metastases confer an independent risk for worse survival in patients with CC. Pelvic lymphadenectomy is important for staging and regional disease control when LNs are involved. If a standardized complete lymphadenectomy is performed, the number of LNs is not a significant factor per se.
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy, antonino.ditto@istitutotumori.mi.it.
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lo Vullo
authors.forename: Claudio
authors.initials: C
authors.lastname: Reato
authors.forename: Eugenio
authors.initials: E
authors.lastname: Solima
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Carcangiu
authors.forename: Edward
authors.initials: E
authors.lastname: Haeusler
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*